Maddern, GuyTrochsler, MarkusYoung, Edward2023-01-182023-01-182022https://hdl.handle.net/2440/137250Emergency general surgery has been part of a general surgeon’s workload since the days of modern medicine, yet only in recent times has it been recognised as being a distinct group of vulnerable patients with high morbidity, high mortality and significant healthcare burden. Various key domains that influence outcomes of emergency general surgery have been identified in the literature so far, though few have been conducted in Australia and results do not necessarily take into account of Australia’s unique population geography. Auditing surgical mortality allows identification of deficiencies in current clinical practice, and serves as a starting point for further investigation, with potential to advocate for changes to practise or to provide continued education. The Australian and New Zealand Audit of Surgical Mortality and the Collaborating Hospital’s Audit of Surgical Mortality have been established for well over 10 years now, but there are still aspects of clinical practice that have not been investigated. Appendicectomy is the most common emergency intra-abdominal surgery performed. With high frequency and low morbidity, appendicectomy is often used to benchmark various aspects of clinical practice. There are also emerging reports that appendicitis in the elderly is not as benign as once thought to be, and perhaps management ought to be different. Understanding appendicectomy outcomes in Australia help to shed some light to these questions and facilitate comparisons with international studies. With 28% of the Australian population residing in inland rural or remote regions, interhospital transfers play a pivotal role in providing timely surgical care. There is conflicting evidence in the non-Australian literature as to whether interhospital transfers affect patient outcomes. Local studies have not been carried out at a national level, and the effect of interhospital transfer on mortality outcomes of patients in Australia is unknown. The aim of the thesis was to investigate deaths in emergency surgery in Australia, with a specific focus on outcomes of appendicectomies and interhospital transfers. Analysis of national surgical mortality audit data found mortality of appendicectomies in Australia was very low and on par with other developed countries. Surgical management was satisfactory in most fields, however post-operative care in the elderly was found to be poor at times. There is a paucity of knowledge in the literature regarding interhospital transfer delays in emergency general surgery patients. Australia currently does not have a national prospective clinical registry which captures outcomes of surgical patient transfers despite geographical size. Predictors of interhospital transfer delays identified from the mortality audit, included female gender, number of comorbidities, rural and remote transfer, major non-trauma non-vascular specialty, patient factors, clinical assessment, communication and transfer system. More work needs to be done to prospectively examine the effects of interhospital transfer and elderly age on emergency general surgical patients, with a view to verify the findings identified so far. Some of the factors identified are potentially modifiable, and may have clinical significance.engeneral surgery, Australia, interhospital transfer, emergencyThesis